Provider Demographics
NPI:1275937955
Name:JESSICA HUYNH OD PC
Entity Type:Organization
Organization Name:JESSICA HUYNH OD PC
Other - Org Name:KUBO OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-335-9655
Mailing Address - Street 1:1737 DIAMOND WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4601
Mailing Address - Country:US
Mailing Address - Phone:916-335-9655
Mailing Address - Fax:
Practice Address - Street 1:2401 15TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2238
Practice Address - Country:US
Practice Address - Phone:916-443-8034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty